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The Impact of Adjuvant Therapy on Survival and Recurrence Patterns in Women With Early-Stage Uterine Carcinosarcoma: A Multi-institutional Study
  1. David M. Guttmann, MD, MTR*,
  2. Hualei Li, MD, PhD,
  3. Parag Sevak, MD,
  4. Surbhi Grover, MD, MPH*,
  5. Geraldine Jacobson, MD, MPH§,
  6. Aharon Feldman, BA,
  7. Stephen Rubin, MD,
  8. Christina Chu, MD,
  9. Sudershan Bhatia, MD, PhD,
  10. Mohamed A. Elshaikh, MD and
  11. Lilie L. Lin, MD*
  1. *Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA;
  2. Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA;
  3. Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI;
  4. §Department of Radiation Oncology, West Virginia University, Morgantown, WV; and
  5. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA.
  1. Address correspondence and reprint requests to Lilie L. Lin, MD, Department of Radiation Oncology, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, PCAM/TRC 4 West, Philadelphia, PA 19104. E-mail:


Objective The aim of the study was to characterize the impact of adjuvant therapy on survival in women with stage I/II uterine carcinosarcoma after primary surgery.

Methods We reviewed records of 118 consecutively treated women with 2009 International Federation of Gynecology and Obstetrics stage I/II uterine carcinosarcoma who underwent hysterectomy between 1990 and 2014 at 4 academic institutions. Patients were categorized by adjuvant treatment group into observation, chemotherapy only, radiation only, and combined chemotherapy and radiation. Survival analyses were conducted using Kaplan-Meier and Cox proportional hazards models.

Results Median follow-up was 28 months (range, 1–244 months). Lymphadenectomy was performed in 94 patients (80%). Postoperative management included observation (n = 37 [31%]), chemotherapy alone (n = 19 [16%]), radiation therapy (RT) alone (n = 24 [20%]), and combined RT and chemotherapy (n = 38 [32%]). Radiation therapy modality included vaginal brachytherapy in 22 patients, pelvic external beam RT in 21 patients, and combination in 19 patients. In 58% of women, chemotherapy consisted of carboplatin/paclitaxel. Median overall survival for all women was 97 months. On univariate analysis, adjuvant treatment group was associated with improved overall survival (hazard ratio [HR], 0.74; confidence interval [CI], 0.58–0.96; p = 0.02), freedom from vaginal recurrence (HR, 0.55; CI, 0.37–0.82]; p = 0.004), and freedom from any recurrence (HR, 0.70; CI, 0.54–0.92; p = 0.01). Pairwise comparisons demonstrated a significant benefit to chemoradiation over other adjuvant treatments. Adjuvant treatment group remained a significant covariate for all 3 end points on multivariate analysis as well. In addition, lymphadenectomy improved overall survival on multivariate analysis (HR, 0.24; CI, 0.09–0.61; p = 0.003). Of patients under observation only who had a recurrence, 8 (44%) of 18 had a recurrence in the vagina as the sole site of recurrence. By contrast, of women who received vaginal brachytherapy, significantly fewer had a recurrence in the vagina (1/42 [2.3%]; p < 0.003, log-rank test).

Conclusions In women with early-stage uterine carcinosarcoma, our data suggest superior survival end points with combined RT and chemotherapy. The frequency of vaginal recurrence suggests a role for incorporating vaginal brachytherapy in the adjuvant management of this disease.

  • Adjuvant
  • Brachytherapy
  • Carcinosarcoma
  • Chemotherapy
  • Prognosis
  • Radiation treatment
  • Recurrence
  • Uterine neoplasms

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  • The authors declare no conflicts of interest.